(327) A Multicenter Retrospective Analysis of Pediatric Clinical Ethics Consultations

Introduction: As pediatric critical care becomes increasingly complex, providers often request clinical ethics consultations (CECs) to navigate ethically and morally challenging situations. It is well established that pediatric and neonatal intensive care units are the highest utilizers of CECs. Prior studies describe the characteristics of pediatric CECs at single centers. No multi-center study has characterized the pediatric patients who receive CECs and what ethical issues predominate. There is also little known about the relationship between health disparities and pediatric CECs. We will present data from a study that fills those literature gaps. Our multi-center study collects and analyzes data about CECs conducted over five years at five geographically diverse, academic pediatric centers.

Methods: This is a retrospective review of CECs at Ann & Robert H. Lurie Children's Hospital of Chicago, Children’s Hospital Los Angeles, Johns Hopkins Children’s Center, Monroe Carell Jr. Children’s Hospital at Vanderbilt, and Seattle Children’s Hospital. We included patients aged 0-25 years who received CECs from 1/1/2016 to 12/31/2021. This study describes the population for whom CECs were requested and the indications for those consults using the Armstrong Clinical Ethics Coding System. We are characterizing the patient population using descriptive statistics. We are comparing proportions for categorical variables and means for continuous variables to investigate for significant differences between those patients receiving CECs and the general population at each hospital.

Results: Our results will increase understanding of why and for whom pediatric CECs are requested. We anticipate that this study will show that there are racial, ethnic, or socioeconomic disparities between those families who receive CECs compared to the general hospital population. We expect that these disparities will exist across centers.

Conclusions: This study explores unanswered questions within clinical bioethics including: Who are the pediatric patients receiving CECs? How do these populations differ between institutions? Are there racial, ethnic, or socioeconomic disparities related to who receives CECs? This work will inform our future work to understand any disparities discovered and investigate why and how those disparities exist.